Imaging Technique Reveals Key Features of Nail Diseases

TOPLINE:
Nailfold capillaroscopy identifies distinct changes in capillary density, length, and morphology in patients with conditions such as nail psoriasis, onychomycosis, and retronychia.
METHODOLOGY:
The single-center, observational cross-sectional pilot study evaluated patients aged ≥ 7 years with newly diagnosed nail disorders between January 2022 and May 2023.
A total of 128 patients (average age, 46.1 years; range, 8-84 years) with nail psoriasis, onychomycosis, idiopathic/traumatic onycholysis, brittle nail syndrome, nail lichen planus, retronychia, and other nail conditions and those with no nail findings (controls) were enrolled.
Researchers performed nailfold capillaroscopy imaging and compared capillary features between patients with nail conditions and the controls.
TAKEAWAY:
Patients with nail psoriasis had decreased capillary density and length (P < .001), more crossed and tortuous capillaries (P < .02), and increased abnormal capillary morphology (P = .03) compared with controls. Specific abnormalities, such as branching and meandering capillaries, were more common among those with nail psoriasis (both 26.5%).
Patients with fingernail and toenail onychomycosis had a higher frequency of abnormal capillary morphology (P < .02), particularly meandering capillaries (75.0% for fingernails and 76.9% for toenails). However, other abnormalities were less frequently observed.
Patients with nail lichen planus (P < .01), onychopapilloma (P = .01), and retronychia (P = .03) showed significantly shorter capillaries than controls. Retronychia was also associated with increased disorganized polymorphic capillaries (P = .02).
Patients with brittle nail syndrome and eczema showed no significant differences compared with controls.
IN PRACTICE:
“Our findings highlight nailfold capillaroscopy as a potentially quick, cost-effective, and noninvasive imaging modality as an adjunct for diagnosis and treatment initiation for patients with onychodystrophies,” the authors wrote.
SOURCE:
This study was led by Jonathan K. Hwang, MD, Weill Cornell Medicine, New York City, and was published online on September 1 in the Journal of the American Academy of Dermatology.
LIMITATIONS: 
The study’s limitations included a small sample size for certain nail conditions and the single-center design, which limited generalizability. Additionally, the uneven surface, scaling, onycholysis, and thickening of toenails made some capillaroscopy images difficult to capture and interpret.
DISCLOSURES:
The study did not receive any funding. One author reported serving as a consultant for Eli Lilly, Ortho-Dermatologics, BelleTorus Corporation, and Moberg Pharma AB.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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